Statutory Regulation of Psychotherapists and Counsellors: Challenges and Considerations

Many healthcare professions in the UK are statutorily regulated, meaning practitioners must meet defined standards of education, training, and conduct to use their professional titles and provide services. This statutory framework also grants regulatory bodies, such as the General Medical Council (GMC) and the Health and Care Professions Council (HCPC), disciplinary powers to address allegations of professional misconduct.

Perhaps surprisingly, the roles of psychotherapists and counsellors remain largely unregulated, leaving these professions outside the frameworks that govern other healthcare practitioners.

Definitions

According to the British Association for Counselling and Psychotherapy (BACP):

• A psychotherapist works with individuals, groups, or families to explore deep-seated issues, often through long-term, intensive therapy. The role is grounded in helping clients achieve insight and change by addressing underlying psychological concerns.

• A counsellor offers a more focused and often shorter-term approach, providing a safe and supportive environment for individuals to discuss specific challenges and develop coping strategies.

Current Regulatory Framework

Oversight of these professions primarily relies on voluntary bodies.  Organisations such as the BACP and the UK Council for Psychotherapy (UKCP) uphold professional standards through membership criteria and codes of practice. Many practitioners choose to register with these bodies to access training and educational resources and to lend credibility to their services. 

However, this voluntary system allows practitioners to operate without mandatory registration, arguably leaving significant gaps in professional accountability. 

Push for Regulatory Scrutiny

The adequacy of the current regulatory framework has come under increasing scrutiny recently. 

In June 2023, Ella Janneh successfully sued TV "sex therapist" Michael Lousada for a significant sum, alleging rape and sexual assault at his London clinic under the guise of a "therapeutic technique." Since a number of others have made similar claims of abuse by therapists – in part leading to a campaign for statutory regulation. Campaigners are set to meet with MPs in December to discuss potential legislation.

Of course, incidents like this are not reflective of the wider profession, and those who work hard to uphold the standards expected of professionals, but it begs the question as to whether mandatory statutory regulation would move the dial forward on public safety.

Experts have also raised concerns about the lack of oversight. Professor Dame Til Wykes of King’s College London warned about the proliferation of unregulated online mental health platforms, many of which lack rigorous evaluation or controlled trials. Similarly, Lisa Morrison Coulthard, Director of Professional Standards at the BACP, criticised the rise of "influencer therapists" sharing potentially harmful content. With rising demand for therapeutic support, she stressed the need for access to qualified professionals offering appropriate therapies.

MPs, including Labour's Chris Webb, have called for statutory regulation. Webb, who will be an officer on the all-party parliamentary group on mental health, stated that statutory regulation of psychotherapists and counsellors would be a top priority. Drawing from personal and professional experience, he highlighted that while some unregulated therapists may have good intentions, they often lack the necessary training, making regulation essential to protect vulnerable individuals.

Regulatory Implementation Considerations

The introduction of statutory regulation for psychotherapists and counsellors undoubtedly presents significant challenges. A previous attempt in 2010 to regulate the profession through the HCPC failed due to legal challenges. Experts, including Professor Andrew Samuels, the former Chair of the UKCP, caution that rushing into regulation could divide the profession, which has only recently achieved fragile unity through the Professional Standards Authority (PSA). Instead, he advocates for a national campaign to inform the public that they should only work with therapists listed with a PSA-accredited register.

Key regulatory challenges include defining the scope of therapeutic practices and deciding which titles should be protected. Experts like Philippa Smethurst, a senior accredited member of BACP, argue that psychotherapy, with its established training pathways, is easier to regulate than counselling, where training standards vary and the methods used by counsellors rightly vary depending on their training and clients.  Psychotherapist Sue Lieberman highlights that the real issue lies in inadequate training, which could be addressed by regulating course providers rather than individual practitioners.

While the PSA’s Accredited Registers programme ensures that therapists meet high governance standards, it does not prevent unqualified individuals from using protected titles. Statutory regulation could provide stronger public protection but would require careful consideration to implement. 

The introduction of regulation would demand substantial restructuring of existing bodies, with voluntary organisations like BACP and UKCP possibly transitioning to professional membership bodies, while statutory regulators would need to expand their expertise in therapeutic practices. Moreover, the operational complexities, such as the need for significant resources, developing comprehensive registration processes and disciplinary procedures, and managing costs, would add further strain. 

The diversity of therapeutic techniques presents a fundamental challenge to standardisation. Any regulatory framework should balance public safety with professional flexibility, ensuring it supports a wide range of therapeutic approaches.

Conclusion

The regulation of psychotherapists and counsellors remains a complex and nuanced issue. The current voluntary system has both strengths and limitations, with professional bodies like BACP and UKCP providing important guidance while also leaving room for debate about comprehensive oversight.

Ultimately, if MPs are to bring in a new framework, it must ensure robust public protection while also maintaining professional flexibility and addressing the operational and financial challenges of expanding regulatory capacity.